Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, Hamilton, Ontario, Canada.
J ISAKOS. 2021 Mar;6(2):94-101. doi: 10.1136/jisakos-2020-000438. Epub 2020 Nov 3.
Acute pseudoseptic arthritis is a rare complication of hyaluronic acid (HA) injections that is not well documented in the literature. Practitioners initially suspect the symptoms of this complication to represent septic arthritis, cautiously prescribing antibiotics. This review identifies that time to presentation of symptoms postinjection, negative cell cultures and lack of crystallisation could be used as differentials to suspect pseudoseptic arthritis and to prescribe anti-inflammatory drugs while closely monitoring change of symptoms.
The purpose of this study was to describe the presentation, diagnosis and treatment of pseudoseptic arthritis.
A systematic review of the literature was conducted for studies reporting the use of HA injections for osteoarthritis resulting in pseudoseptic arthritis using the electronic databases MEDLINE, Embase and PubMed. Pertinent data were abstracted from the search yield. A unique case of a pseudoseptic reaction is also presented.
A total of 11 studies (28 cases), all of level IV and V evidence were included in this review. Reported cases of pseudoseptic arthritis in the literature present with severe joint pain (100%), effusion (100%), inability to weight-bear, functional impairment, and occasionally fever (22.2%). C reactive protein and erythrocyte sedimentation rate are generally elevated (71.4% and 85.7%, respectively), and leucocytosis above 10 000 was less common (50%). All reported cases in the literature identified aseptic growth on arthrocentesis, despite four cases (15.4%) reporting synovial leucocyte counts above 50 000. The presented case is the highest reported leucocyte count at 1 74 960 cells/mm.
Acute pseudoseptic arthritis is rare, but a number of cases have been reported in the literature. A high degree of suspicion for pseudoseptic arthritis may be maintained in patients who present under 72 hours following HA injection. Initial antibiotic treatment, along with anti-inflammatory medications until cultures are confirmed to be negative at 5 days, is a cautious approach. However, the strength of this conclusion is limited by the few reported cases. Ultimately, this review is intended to inform practitioners of the symptoms, diagnosis and treatment of this complication, such that it could be safely differentiated from septic arthritis.
IV.
重要性：急性假性脓毒性关节炎是透明质酸（HA）注射的罕见并发症，在文献中记录不详。从业者最初怀疑这种并发症的症状是脓毒性关节炎，谨慎地开了抗生素。本综述确定了注射后症状出现的时间、细胞培养阴性和无结晶可作为鉴别假性脓毒性关节炎的指标，并在密切监测症状变化的同时开抗炎药。
目的：本研究旨在描述假性脓毒性关节炎的表现、诊断和治疗。
证据回顾：对电子数据库 MEDLINE、Embase 和 PubMed 中报道的使用 HA 注射治疗骨关节炎导致假性脓毒性关节炎的研究进行了系统综述。从搜索结果中提取了相关数据。还介绍了一个独特的假性脓毒性反应病例。
发现：共纳入 11 项研究（28 例），均为 IV 级和 V 级证据。文献中报道的假性脓毒性关节炎病例均表现为严重关节痛（100%）、积液（100%）、无法负重、功能障碍，偶尔发热（22.2%）。C 反应蛋白和红细胞沉降率通常升高（分别为 71.4%和 85.7%），白细胞计数超过 10000 的情况较少见（50%）。文献中所有报道的病例在关节穿刺术时均发现无菌生长，尽管有 4 例（15.4%）报告滑膜白细胞计数超过 50000。本病例报告的白细胞计数最高，为 174960 个细胞/mm。
结论和相关性：急性假性脓毒性关节炎罕见，但文献中有许多报道。对于在 HA 注射后 72 小时内出现的患者，应高度怀疑假性脓毒性关节炎。在培养结果在 5 天内证实为阴性之前，最初使用抗生素治疗和抗炎药物治疗是一种谨慎的方法。然而，由于报道的病例较少，这一结论的力度有限。最终，本综述旨在告知从业者这种并发症的症状、诊断和治疗方法，以便能够安全地区分其与脓毒性关节炎。
证据水平：IV。
